Asymptomatic free gas post Endoscopic Mucosal Resection (EMR) - Is surgical intervention always necessary?

Background& ObjectivesEndoscopic mucosal resection (EMR) is an efficient, cost-effective and minimally-invasive mode of treatment of colonic polyps. Colonic perforation post EMR is one of the potential complications associated with this procedure. Some patients may present with asymptomatic free gas on imaging and therefore not necessarily require intervention.MethodsWe present a case series of patients undergoing EMR who were found to have intra-abdominal free gas or ‘bowel perforation’ on imaging post procedure. They were all asymptomatic and did not warrant emergency surgical intervention. In addition, we aim to provide a review of the existing literature on ‘bowel perforation’ post EMR and discuss its management.Results & ConclusionThrough this case series we highlight the importance of assessing patients clinically and not treating the radiological findings alone. Clinicians must be aware of the possibility of patients with asymptomatic free gas post EMR as a direct result of the injectate during the procedure or due to the passage of air or CO2 from the distended colon. As the popularity of this procedure increases, it is crucial that clinicians, surgeons and endoscopists are all aware of its associated complications.